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Gut Microbiome and Social Determinants of Health (SDOH)

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Case Report | DOI: https://doi.org/10.31579/2690-4861/060

Gut Microbiome and Social Determinants of Health (SDOH)

  • Suneeta Kumari MD, MPH 1*
  • Saba Afzal MD 1
  • Stacy Doumas MD 1
  • Eric Alcera MD 1
  • Ramon Solhkhah MD 1

Hackensack Meridian Health- Ocean Medical Center- Hackensack Meridian School of Medicine, Brick NJ.

*Corresponding Author: Suneeta Kumari, Hackensack Meridian Health- Ocean Medical Center- Hackensack Meridian School of Medicine, Brick NJ.

Citation: S Kumari, S Afzal, S Doumas, E Alcera, R Solhkhah. (2020) Gut Microbiome and Social Determinants of Health (SDOH). International Journal of Clinical Case Reports and Reviews. 4(2);DOI: 10.31579/2690-4861/060

Copyright: © 2020 Suneeta Kumari, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Received: 16 September 2020 | Accepted: 30 September 2020 | Published: 05 November 2020

Keywords: Gut Microbiome; SDOH; human microbiota

Abstract

With technological advancements in the medical field, new discoveries have been unfolded about the human microbiota. A tremendous amount of work has been studied within the last two decades. Some of the human microbiota sites include nonsterile areas such as mouth, skin, gut, nose, and vagina. Additionally, there are bacterial cells in areas that were considered sterile such as lungs and placenta before delivery. Out of all the sites, the gut houses the most with an amount of 100 trillion bacteria (Guinane, 2013). Environmental implications have been known to impact these new areas of medicine. There has been a growing interest by the social epidemiologists on how health inequalities impact the role of human gut microbiota.

Introduction

With technological advancements in the medical field, new discoveries have been unfolded about the human microbiota. A tremendous amount of work has been studied within the last two decades. Some of the human microbiota sites include nonsterile areas such as mouth, skin, gut, nose, and vagina. Additionally, there are bacterial cells in areas that were considered sterile such as lungs and placenta before delivery. Out of all the sites, the gut houses the most with an amount of 100 trillion bacteria (Guinane, 2013). Environmental implications have been known to impact these new areas of medicine. There has been a growing interest by the social epidemiologists on how health inequalities impact the role of human gut microbiota.

The gut microbiome has been linked to multiple behavioral health conditions, including depression, PTSD, anxiety, and bipolar disorder. Like other health conditions, a broader social environment shapes the microbiome over the life course. The gut microbiome is influenced by social disparities. Research shows that environmental factors have a greater impact on gut microbiota compared to genetics. There has been a significant resemblance in the composition of the microbiomes of genetically unrelated individuals who live together (Rothschild, 2018).

In this article, authors aimed to explore how early development in life, socioeconomic inequalities, social stressors, and health behaviors can impact the human intestinal microbiome. This review attempts to highlight the scope and mechanism of these influences and how the social environment can influence the human gut microbiota.

There is a growing awareness and interest that gut microbiota can play a crucial role in maintaining homeostasis in health and contribute to the pathogenesis of variety of diseases including disorders of CNS. Several studies have shown role of gut microbiota to influence gut-brain communication in health and disease (Dinan, 2013, Stantan 2017).

Keywords: human microbiome, gut microbiome, social determinants of health, socioeconomic inequalities, health disparities, early development, social stressors, health behavior

Understanding gut-brain axis

 The gut- brain axis is a bidirectional communication system through which the brain modulates/ regulates GI function. In this process several neural, endocrine, and immunological mechanisms play important/ essential role. The intestinal microbiota impacts the GI physiology, including the development and function of enteric nervous system- Also known as second brain- It controls the GI function independently. The enteric system of GI is composed of myenteric and submucosal plexus. Interestingly, recent research findings suggest a potential link of these structures in neurodegenerative disorders- For instance characteristic lewy bodies, pathological hallmarks of Parkinson’s disease, were found in intestinal biopsies of patients with Parkinson’s disease (Lebouvier 2009).

There is increasing evidence that the immune system, inflammation and mucosal barrier function are involved in the pathogenesis of some psychiatric diseases. For instance-in depression, “leaky gut” has been suggested to play a significant pathogenic role- This assumption was based on findings of prevalence and median values for serum IgM and IgA against lipopolysaccharide of enterobacteria in patients with MDD then in normal volunteers (Maes M. Kubera 2008). This study suggested that patient with MDD should be checked for leaky gut by means of IgM and IgA panels and should be treated for leaky gut accordingly.

Effect of gut microbiota on the CNS.

  • Gut microbiome is an integral part of Gut-Brain axis. The interaction between gut microbiome, gut permeability and CNS is BIDIRECTIONAL. (Yarandi 2016)
  • Presence of healthy and diverse gut microbiota is important to normal cognitive and emotional processing. Chronic stress can change composition of gut microbiome.
  • Alteration in composition of gut microbiome DUE TO STRESS can lead to increased intestinal permeability--- lead to translocation of gut microbiota and metabolic product such as lipopolysaccharides through the intestinal barrier.
  • Exposure of epithelial cells or mucosal immune cell to bacteria or metabolic products leads to activation of immune response and release of pro-inflammatory CYTOKINES
  • Subsequently neuroactive compound gain access to the CNS that regulates cognition and emotional responses.
  • Stress can lead to activation of the hypothamus -pitutary axis and excessive release of corticotropin-releasing factor (CRH). This hormone along with altered vagal activity can cause local activation of mast cells in the intestinal wall and release of CYTOKINES, causing increased gut permeability.
Figure 1: A schematic representation of the effects of chronic stress and depression on brain‐gut axis activity. The bi‐directional communication allows signals from the brain corticolimbic structures to alter gastrointestinal function. The HPA axis and immune system are key regulators of this axis.

Gut Microbiota and Depression

According to research on animal model- Depression changes the composition of gut microbiota (Park AJ Collins 2013). These data have not been validated in patient with depression. Recent study (Naseribafrouei 2014) examined the composition of fecal microbiota in 46 patients with depression and 30 healthy controls. This study reported significant differences with increased population of Bacteriodetes, Proteobacteria, Antinibacteria and decreased population of Frimicutes in patients with depression. Other evidence that might suggest role of gut microbiota in the pathogensis of depression is from studies that have shown certain probiotics can alleviate depressive symptoms in rodent models (Park AJ Collins 2013).

According to Dinan 2013 study- A variety of strategies have been used to study the impact of the microbiota on brain function and these include antibiotic use, probiotic treatments, fecal microbiota transplantation, gastrointestinal infection studies, and germ-free studies. All these approaches provide evidence to support the view that the microbiota can influence brain chemistry and consequently behavior (Dinan 2013).

Additionally, research from animal demonstrate that there is a distinct perturbation of the composition of gut microbiota in animal models of depression and chronic stress. This has direct implications for the development of psychobiotic-based therapeutic strategies for psychiatric disorders. Moreover, given that affective co-morbidities, such as major depression and anxiety states, are common in patients presenting with irritable bowel syndrome (IBS), it may have implications for functional bowel disorders as well.

Role of psychobiotic/ probiotics:

Normal gut microbiota is essential in preventing colonization of the harmful bacteria. In the absence of normal flora (antibiotic therapy)- pathogenic organisms produce toxins and colonize the gut epithelium (C. Difficile). Probiotic treatment-reduces gut permeability, enhance mucus production, improve physical barrier protecting the epithelial layer (Yarandi 2016) Treatment of rats with probiotics containing B. infantis can reduce the mood disturbance and correct the concentration on norepi (NE) in the brain (Desbonnet L, 2010). In a model of depression post MI, treatment with probiotics reduce the depression, presumably by reducing the pro-inflammatory cytokines and gut permeability (Arseneault-Breard 2012)

Previous research defines a psychobiotic as a live organism that, when ingested in adequate amounts, produces a health benefit in patients suffering from psychiatric illness. As a class of probiotic, these bacteria can produce and delivering neuroactive substances such as gamma-aminobutyric acid (GABA) and serotonin, which act on the brain-gut axis (Dinen 2013). Preclinical evaluation in rodents suggests that certain psychobiotics possess antidepressant or anxiolytic activity. Effects may be mediated via the vagus nerve, spinal cord, or neuroendocrine systems (Dinen 2017).

To date, psychobiotics have been most extensively studied in a liaison psychiatric setting in patients with irritable bowel syndrome, where positive benefits have been reported for several organisms including Bifidobacterium infantis. Evidence is emerging of benefits in alleviating symptoms of depression. Such benefits may be related to the anti-inflammatory actions of certain psychobiotics and a capacity to reduce hypothalamic-pituitary-adrenal axis activity. Results from large scale placebo-controlled studies are awaited.

In one UK study, 13,000 male and female twins within the age group of 18 and 103 studied sociodemographic and health variables that were matched with microbiota from a previous sample study. This was analyzed using 16 S sequence. Socioeconomic status was measured using the Index of Multiple Deprivation 2015 which encompassed income, employment, education, skills and training, health deprivation and disability, crime, barriers to housing and services, and living environment deprivation based on the postcode. These measures were taken from the Scottish and English/Welsh datasets from the Scottish Government and Public Health England. The microbiota composition was measured in relation to alpha diversity, beta diversity, and differential operational taxonomic units (Bowyer, 2019).

References

  1. Bäckhed, F., Roswall, J., Peng, Y., Feng, Q., Jia, H., Kovatcheva-Datchary, P., Li, Y., Xia, Y., Xie, H., Zhong, H., Khan, M. T., Zhang, J., Li, J., Xiao, L., Al-Aama, J., Zhang, D., Lee, Y. S., Kotowska, D., Colding, C., … Jun, W. (2015). Dynamics and Stabilization of the Human Gut Microbiome during the First Year of Life. Cell Host & Microbe, 17(5), 690–703.
    View at Publisher | View at Google Scholar
  2. Bailey, M. T. (2014). Influence of Stressor-Induced Nervous System Activation on the Intestinal Microbiota and the Importance for Immunomodulation. In M. Lyte & J. F. Cryan (Eds.), Microbial Endocrinology: The Microbiota-Gut-Brain Axis in Health and Disease (pp. 255–276). Springer.
    View at Publisher | View at Google Scholar
  3. Becattini, S., Taur, Y., & Pamer, E. G. (2016). Antibiotic-Induced Changes in the Intestinal Microbiota and Disease. Trends in Molecular Medicine, 22(6), 458–478.
    View at Publisher | View at Google Scholar
  4. Bowyer, R. C. E., Jackson, M. A., Le Roy, C. I., Ni Lochlainn, M., Spector, T. D., Dowd, J. B., & Steves, C. J. (2019). Socioeconomic Status and the Gut Microbiome: A TwinsUK Cohort Study. Microorganisms, 7(1), 17.
    View at Publisher | View at Google Scholar
  5. Carabotti, M., Scirocco, A., Maselli, M. A., & Severi, C. (2015). The gut-brain axis: Interactions between enteric microbiota, central and enteric nervous systems. Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology, 28(2), 203–209.
    View at Publisher | View at Google Scholar
  6. Changes in intestinal microbiota composition and metabolism coincide with increased intestinal permeability in young adults under prolonged physiological stress | American Journal of Physiology-Gastrointestinal and Liver Physiology. (n.d.). Retrieved June 2, 2020.
    View at Publisher | View at Google Scholar
  7. Cigarette smoking and the oral microbiome in a large study of American adults | The ISME Journal. (n.d.). Retrieved June 2, 2020.
    View at Publisher | View at Google Scholar
  8. Desbonnet, L., Garrett, L., Clarke, G., Bienenstock, J., & Dinan, T. G. (2008). The probiotic Bifidobacteria infantis: An assessment of potential antidepressant properties in the rat. Journal of Psychiatric Research, 43(2), 164–174.
    View at Publisher | View at Google Scholar
  9. Dowd, J. B., & Renson, A. (2018). “Under the Skin” and into the Gut: Social Epidemiology of the Microbiome. Current Epidemiology Reports, 5(4), 432–441.
    View at Publisher | View at Google Scholar
  10. Freestone, P. P., Williams, P. H., Haigh, R. D., Maggs, A. F., Neal, C. P., & Lyte, M. (2002). Growth stimulation of intestinal commensal Escherichia coli by catecholamines: A possible contributory factor in trauma-induced sepsis. Shock (Augusta, Ga.), 18(5), 465–470.
    View at Publisher | View at Google Scholar
  11. Galley, J. D., Nelson, M. C., Yu, Z., Dowd, S. E., Walter, J., Kumar, P. S., Lyte, M., & Bailey, M. T. (2014). Exposure to a social stressor disrupts the community structure of the colonic mucosa-associated microbiota. BMC Microbiology, 14(1), 189.
    View at Publisher | View at Google Scholar
  12. Gerber, J. S., Prasad, P. A., Localio, A. R., Fiks, A. G., Grundmeier, R. W., Bell, L. M., Wasserman, R. C., Rubin, D. M., Keren, R., & Zaoutis, T. E. (2013). Racial Differences in Antibiotic Prescribing by Primary Care Pediatricians. Pediatrics, 131(4), 677–684.
    View at Publisher | View at Google Scholar
  13. Goyal, M. K., Johnson, T. J., Chamberlain, J. M., Casper, T. C., Simmons, T., Alessandrini, E. A., Bajaj, L., Grundmeier, R. W., Gerber, J. S., Lorch, S. A., Alpern, E. R., & Network (PECARN), for T. P. C. A. R. (2017). Racial and Ethnic Differences in Antibiotic Use for Viral Illness in Emergency Departments. Pediatrics, 140(4).
    View at Publisher | View at Google Scholar
  14. Guinane, C. M., & Cotter, P. D. (2013). Role of the gut microbiota in health and chronic gastrointestinal disease: Understanding a hidden metabolic organ. Therapeutic Advances in Gastroenterology, 6(4), 295–308.
    View at Publisher | View at Google Scholar
  15. Joynt, M., Train, M. K., Robbins, B. W., Halterman, J. S., Caiola, E., & Fortuna, R. J. (2013). The Impact of Neighborhood Socioeconomic Status and Race on the Prescribing of Opioids in Emergency Departments throughout the United States. Journal of General Internal Medicine, 28(12), 1604–1610.
    View at Publisher | View at Google Scholar
  16. Knowles, S. R., Nelson, E. A., & Palombo, E. A. (2008). Investigating the role of perceived stress on bacterial flora activity and salivary cortisol secretion: A possible mechanism underlying susceptibility to illness. Biological Psychology.
    View at Publisher | View at Google Scholar
  17. Maes, M., Kubera, M., & Leunis, J.-C. (2008). The gut-brain barrier in major depression: Intestinal mucosal dysfunction with an increased translocation of LPS from gram negative enterobacteria (leaky gut) plays a role in the inflammatory pathophysiology of depression. Neuro Endocrinology Letters, 29(1), 117–124.
    View at Publisher | View at Google Scholar
  18. Miller, G. E., Engen, P. A., Gillevet, P. M., Shaikh, M., Sikaroodi, M., Forsyth, C. B., Mutlu, E., & Keshavarzian, A. (2016). Lower Neighborhood Socioeconomic Status Associated with Reduced Diversity of the Colonic Microbiota in Healthy Adults. PloS One, 11(2), e0148952.
    View at Publisher | View at Google Scholar
  19. Prehn-Kristensen, A., Zimmermann, A., Tittmann, L., Lieb, W., Schreiber, S., Baving, L., & Fischer, A. (2018). Reduced microbiome alpha diversity in young patients with ADHD. PLoS ONE, 13(7).
    View at Publisher | View at Google Scholar
  20. Rothschild, D., Weissbrod, O., Barkan, E., Kurilshikov, A., Korem, T., Zeevi, D., Costea, P. I., Godneva, A., Kalka, I. N., Bar, N., Shilo, S., Lador, D., Vila, A. V., Zmora, N., Pevsner-Fischer, M., Israeli, D., Kosower, N., Malka, G., Wolf, B. C., … Segal, E. (2018). Environment dominates over host genetics in shaping human gut microbiota. Nature, 555(7695), 210–215.
    View at Publisher | View at Google Scholar
  21. Singh, R. K., Chang, H.-W., Yan, D., Lee, K. M., Ucmak, D., Wong, K., Abrouk, M., Farahnik, B., Nakamura, M., Zhu, T. H., Bhutani, T., & Liao, W. (2017). Influence of diet on the gut microbiome and implications for human health. Journal of Translational Medicine, 15(1), 73.
    View at Publisher | View at Google Scholar
  22. Smoking and the intestinal microbiome | SpringerLink. (n.d.). Retrieved June 2, 2020.
    View at Publisher | View at Google Scholar
  23. Systematic review: Human gut dysbiosis induced by non‐antibiotic prescription medications—Le Bastard—2018—Alimentary Pharmacology & Therapeutics—Wiley Online Library. (n.d.). Retrieved June 2, 2020.
    View at Publisher | View at Google Scholar
  24. Witt, W. P., Wisk, L. E., Cheng, E. R., Mandell, K., Chatterjee, D., Wakeel, F., Godecker, A. L., & Zarak, D. (2015). Determinants of Cesarean Delivery in the U.S.: A Lifecourse Approach. Maternal and Child Health Journal, 19(1), 84–93.
    View at Publisher | View at Google Scholar
  25. Wu, G. D., Chen, J., Hoffmann, C., Bittinger, K., Chen, Y.-Y., Keilbaugh, S. A., Bewtra, M., Knights, D., Walters, W. A., Knight, R., Sinha, R., Gilroy, E., Gupta, K., Baldassano, R., Nessel, L., Li, H., Bushman, F. D., & Lewis, J. D. (2011). Linking long-term dietary patterns with gut microbial enterotypes. Science (New York, N.Y.), 334(6052), 105–108.
    View at Publisher | View at Google Scholar
  26. Zheng, P., Zeng, B., Zhou, C., Liu, M., Fang, Z., Xu, X., Zeng, L., Chen, J., Fan, S., Du, X., Zhang, X., Yang, D., Yang, Y., Meng, H., Li, W., Melgiri, N. D., Licinio, J., Wei, H., & Xie, P. (2016). Gut microbiome remodeling induces depressive-like behaviors through a pathway mediated by the host’s metabolism. Molecular Psychiatry, 21(6), 786–796.
    View at Publisher | View at Google Scholar

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